International journal of clinical practice. Supplement
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Int J Clin Pract Suppl · Oct 2004
Review Comparative StudySymptomatic treatment of osteoarthritis: paracetamol or NSAIDs?
The clinical management of osteoarthritis (OA) is today symptomatic, its main goals being relief of pain and improvement of function. Therapy should be multimodal and composed of non-pharmacological, pharmacological and, if necessary, surgical procedures. Paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) are evidence-based drugs for the symptomatic relief of OA. ⋯ With regard to efficacy, safety and cost, the majority of new guidelines recommend paracetamol as a first-choice analgesic for patients with OA of the knee or hip, and the use of NSAIDs only in cases of inadequate effect of paracetamol and especially in the presence of inflammation. There is much evidence that OA is a phasic disease and it may be that NSAIDs are useful during identifiable periods of inflammatory activity and can be avoided at other times. The concept of the short-term use of NSAIDs during flares and the use of a simple analgesic in the long term seems to be the best variant for the majority of patients with optimal benefit/risk and cost-effectiveness.